Does Medicare Cover Allergy Testing?

Allergies can significantly impact daily life, ranging from mild discomfort to severe reactions. For many individuals, identifying specific triggers is crucial for effective management. Medicare, the federal health insurance program for people aged 65 or older and certain younger people with disabilities, covers various medical services, including allergy testing. Understanding this coverage is important for beneficiaries.

Medicare Coverage for Allergy Testing

Medicare covers allergy testing when medically necessary to diagnose or rule out a suspected allergic condition. This coverage falls under Medicare Part B. For a test to be covered, a physician must order it as part of a diagnostic process, following a complete medical history review and a physical examination. The testing must also be performed in a Medicare-approved laboratory or facility.

Medicare Part B covers several types of allergy tests. These include percutaneous tests (skin prick, scratch, or puncture tests), which involve applying small amounts of allergens to the skin. If initial skin tests are negative, intradermal tests, where allergens are injected just beneath the skin, may also be covered. Blood tests that measure specific antibodies (like IgE) to identify allergens are also covered when medically necessary. Food challenge tests, conducted on an outpatient basis under medical supervision, can be covered if required for diagnosis.

Understanding Your Costs for Allergy Testing

Beneficiaries should understand the financial responsibilities for Medicare-covered allergy testing. Under Original Medicare Part B, after meeting the annual deductible, Medicare pays 80% of the Medicare-approved amount for covered services. Beneficiaries are responsible for the remaining 20% coinsurance. For 2025, the standard Medicare Part B annual deductible is $257.

Medicare Advantage Plans (Part C) are offered by private companies and must provide at least the same coverage as Original Medicare. These plans also cover medically necessary allergy testing. Out-of-pocket costs, such as copayments and coinsurance, can vary based on the plan’s structure and network rules. Medigap policies, or Medicare Supplement Insurance plans, can help cover some out-of-pocket costs not paid by Original Medicare, including the Part B coinsurance and potentially the deductible.

Steps to Ensure Your Allergy Test is Covered

To ensure Medicare coverage for allergy testing, beneficiaries should take proactive steps. Ensure the allergy test is prescribed by a physician enrolled in Medicare who accepts Medicare assignment. This ensures the doctor agrees to accept the Medicare-approved amount as full payment for services. The testing must also be performed at a Medicare-approved facility or laboratory.

Proper documentation of medical necessity is important. Your physician must provide clear documentation demonstrating why the allergy testing is necessary, such as a history of allergic reactions or symptoms not responding to other therapies. The physician should also confirm the testing is an initial step in a comprehensive, Medicare-approved treatment program. Consult with your healthcare provider and, if necessary, your specific Medicare plan provider before undergoing an allergy test to confirm coverage and understand potential out-of-pocket expenses.